Servicesforpreventionofmother-to-child-transmission(PMTCT)ofHIVhavebeenscaledupacrossUganda, yetoneinfivenewHIVcasesstillresultfromverticaltransmission.Thisisinlargepartdueto~30%ofHIV+ mothersnotreceivingPMTCTcare;andofthosewhodo,two-thirdsdonotadheretothefullPMTCTcare continuum.Over30%ofHIV+pregnantwomenareclinicallydepressed,anddepressionhasharmfuleffects onadherencetothePMTCTcarecontinuum,yetmentalhealthcareisabsentinUgandanantenatalcare (ANC) clinics,leavingdepressionrarelydiagnosedandtreated.Researchisneededtoestablishaviablemodelfor treatingdepressioninthecontextofPMTCTcare,andtounderstandhowdepressiontreatmentmaymitigate theharmfuleffectsofdepressiononPMTCTadherencesothatoptimalpregnancyoutcomescanbeachieved. Whilethereissomeevidencethatdepressiontreatmentanddepressionalleviationimproveadherenceto generalHIVcareprocesses,suchbenefitshavenotbeenevaluatedinthemorecomplexPMTCTcare continuum,whichincludesnotonlymaternalARTuse(bothpre-andpost-natal),butalsochilduseofART prophylaxis,periodicchildHIVtesting,anduniformbreastfeeding.Buildingonourpriorresearchinintegrating task-shifteddepressioncareintoHIVclinicsinUganda,andouruseofproblemsolvingtherapy(PST)and antidepressanttherapy(ADT)fortreatingdepressioninlowresourcesettings,administeredbytrainedlay personsandnurses,respectively,thisapplicationproposesaclusterRCTtocomparetheeffectsofan evidence-baseddepressioncaremodelvs.usualcareonadherencetoeachstepofthePMTCTcare continuumat8ANCclinicsinUganda.UsualcareinUgandanANCclinicsincludesreferralstopsychiatric specialistsindistricthospitals,aswellastheMinistryofHealth?sFamilySupportGroup(FSG)programfor HIV+women,whichprovidespsychosocialsupportthroughgroupeducationtohelpwomenadheretoPMTCT careandmanagetheirpregnancy.Atthe4experimentalsiteswewilladdtousualcarethegoldstandard, steppedcareapproachtoprovidingevidence-baseddepressiontreatmentconsistingofPST(viaindividual counseling,andcontentintegratedintospecificFSGgroupsessions)orADT(forwomenwithsevereor refractorydepression,orwhorefusePST).Ateachsite,50HIV+pregnantwomen(n=400)whoscreenpositive forpotentialdepressionwillenrollandbefolloweduntil18-monthspost-delivery.Primaryoutcomesconsistof maternalviralsuppressionandadherencetoeachstepofthePMTCTcarecontinuum.Wewillevaluatethe incrementalcost-effectivenessofintegratingevidence-baseddepressioncare,relativetousualcare.If efficaciousandcost-effective,thisstudywillprovideamodelforintegratingdepressioncareintoANCclinics andpromotingoptimaladherencetothePMTCTcarecontinuumandmaternalandchildhealthoutcomes.